异基因造血干细胞移植后膜性肾病1例

背景：移植物抗宿主病的诊断与膜性肾病发病关系密切。 目的：观察异基因造血干细胞移植后肾脏损害的临床特征，以期早期诊断移植物抗宿主病。 方法：回顾性分析1例急性白血病异基因造血干细胞移植后合并膜性肾病患者的临床表现及治疗转归。 结果与结论：患者临床表现为大量蛋白尿、高脂血症、低白蛋白血症等肾病综合征特征，同时眼干、口干等慢性移植物抗宿主病表现加重。肾脏病理诊断为膜性肾病。应用免疫抑制剂如泼尼松、他克莫司及雷公藤等治疗4个月后尿蛋白转阴，临床症状改善。随访3年病情无反复，生活质量好。提示异基因造血干细胞移植后肾脏损害是慢性移植物抗宿主病的一种特殊表现，加强免疫抑制治疗后转归良好，肾脏病理检查对诊断有重要意义。 关键词：膜性肾病；造血干细胞移植；移植物抗宿主病；肾活检；免疫抑制 doi:10.3969/j.issn.1673-8225.2012.06.022

Membranous nephropathy after allogeneic hematopoietic stem cells transplantation in one case

BACKGROUND: Graft-versus-host disease (GVHD) in patients is closely related with membranous nephropathy. OBJECTIVE: To investigate the clinical features of renal damage associated with allogeneic hematopoietic stem cells transplantation (Allo-HSCT) in order to do the early diagnosis of GVHD. METHODS: A retrospective analysis of clinical presentation and the follow-up therapy and vesting of 1 case of membranous nephropathy after acute leukemia Allo-HSCT. RESULTS AND CONCLUSION: The clinical manifestations in patient were severe proteinuria, hyperlipidemia, hypoalbuminemia and other features of nephrotic syndrome, and dry eyes, dry mouth and other performance of chronic graft-versus-host disease (cGVHD) was increased. Pathological diagnosis of membranous nephropathy was made. After the treatment of immunosuppressants such as prednisone, tacrolimus and triptolide for 4 months, the proteinuria was negative, clinical symptoms were improved. Up for 3 years without recurrent disease and the life quality was better. Chronic kidney damage is a special performance of cGVHD after Allo-HSCT and the vesting is good with the treatment of immunosuppressive therapy, pathological examination of renal was important for diagnosis.